Nursing activities and factors influential to nurse staffing decision-making

Abstract

Objective: There is limited published research supporting the effectiveness of nursing workload measurement to comprehensively measure nursing workload and to formulate nurse resource need. Predictive accuracy is impaired due to variation in direct and indirect care-related activities across measurement instruments. This study aimed to (1) identify common nursing activities considered by nurse managers for staffing decision-making, (2) systematically review such nursing activities in relation to existing nursing workload instruments and Nursing Intervention Classification taxonomy, and (3) describe challenges perceived by managers in staffing decision-making. Methods: A survey was developed from an inclusive review of 20 nursing workload instruments collectively measuring 502 nursing activities. Nurse managers in 13 medical-surgical and two intensive care units at a Midwest healthcare organization identified nursing activities considered daily for staffing decision-making. Results: Twenty-one activities were commonly considered by at least 90 percent of managers (n = 13) for daily staffing decisionmaking, although none of the instruments reviewed included all 21 activities. Conclusions: Lack of a standardized framework for nursing workload measurement might have led to nurse managers' different perceptions about appropriate determinants of these measurements. A standardized approach for measuring nursing workload would facilitate benchmarking for estimating nurse resource need. Further research is needed to design a systematic infrastructure that ensures staffing to meet patient care need. A process is also needed to alleviate the challenges in staffing decision-making that nurse managers face, such as fluctuations in census and patient acuity, nurse competency-based patient assignments, and limited information resources for staffing estimation.

Workload of nurses: observational study of indirect care activities/interventions

“…The mapping of 502 Nursing activities in North American hospitals (29) identified 21 of these as commonly being considered by 90% of nursing managers for daily decision making on Nursing staff. These included four indirect care activities (documentation, health care information exchange, case management and change-in-shift).…”

Patient acuity and nurse staffing challenges in Norwegian neonatal intensive care units

“…A variety of different nurse‐workload measurement instruments have been developed to measure more accurately the nurse workload, but a standardized approach does not exist (Young et al . ).…”

“…The use of a patient classification system to calculate NPR and determine nurse workload is not always representative of the actual workload, as patient classification does not consider the amount of time nurses spend on support of parents in crisis, parental and student guidance and other nurse-related procedures. A variety of different nurse-workload measurement instruments have been developed to measure more accurately the nurse workload, but a standardized approach does not exist (Young et al 2015).…”

Ward staffing guided by a patient classification system: A multi‐criteria analysis of “fit” in three acute hospitals

“…often carrying out unobservable work such as critical thinking, and responding to emerging demands and prioritizing (Hughes, 1999). Furthermore the needs and numbers of patients are frequently changing and unpredictable (Edwardson & Giovannetti, 1994;Young et al, 2015), while staff schedules are subject to work regulations and satisfaction requirements. Given this complexity, it is clear why there is no simple, generally applicable method for determining a safe number of nursing staff to employ on a ward (Arthur & James, 1994;Fasoli & Haddock, 2010).…”